Provider Demographics
NPI:1710061460
Name:HORNER, BYRON H (MSPT)
Entity Type:Individual
Prefix:MR
First Name:BYRON
Middle Name:H
Last Name:HORNER
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-0013
Mailing Address - Country:US
Mailing Address - Phone:435-654-0804
Mailing Address - Fax:435-654-3314
Practice Address - Street 1:228 WEST STATE ROAD 248
Practice Address - Street 2:SUITE A
Practice Address - City:KAMAS
Practice Address - State:UT
Practice Address - Zip Code:84036-9595
Practice Address - Country:US
Practice Address - Phone:435-783-2659
Practice Address - Fax:435-783-2660
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4819784-2401225100000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist